Provider Demographics
NPI:1376056705
Name:JACOBS, CASSIDY LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:LYNNE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-8059
Mailing Address - Country:US
Mailing Address - Phone:479-459-8350
Mailing Address - Fax:
Practice Address - Street 1:13700 DAVID O DODD RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-2747
Practice Address - Country:US
Practice Address - Phone:501-907-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant